Provider Demographics
NPI:1437048758
Name:SOAR SUPPORTED LIVING
Entity type:Organization
Organization Name:SOAR SUPPORTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMASELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:986-282-0029
Mailing Address - Street 1:2528 N HICKORY WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-8077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:271 N. AVE. D
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634
Practice Address - Country:US
Practice Address - Phone:986-282-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency